Ben Goldacre, a British physician and writer, makes a prediction in this week's BMJ (subscription required for full article access):

"I'd like to make a sage prediction, seeing as it's early December. One of the joys of watching bad science coverage in the media—as I have done for four years now—is that you start to spot patterns: and this year, just like every Christmas, as regular as mince pies, I can confidently predict a specific rash of stories: they will explain solicitously that chocolate is good for you—"actually"—and red wine is even better.

It's not much of a prediction, since in the world of public relations, Christmas has started already. "Choxi+" is milk chocolate with "extra antioxidants," and the newspapers are fawning over it already: "too good to be true," says the Daily Mirror; "chocolate that is good for you, as well as seductive," says the DailyTelegraph. The company is said to "recommend" two pieces of its chocolate a day. "Guilt free," says the Daily Mail: it's "the chocolate bar that's ‘healthier' than 5lb of apples." Meanwhile, Sainsbury's is promoting Red Heart wine—with extra antioxidants—as if drinking the stuff was a duty to your grandchildren.

These products represent triumphs of over-extrapolation from observational data, and laboratory hunches. ...

The antioxidant story took a bit of a blow, of course, when people started to do placebo controlled randomised trials with antioxidant vitamin supplements, to see what happened: because overall they seem to do nothing, or at worst, reduce life expectancy. And that's when you might start to think, well now, perhaps people who eat fresh fruit and vegetables are, just like the people who drink red wine in decorous moderation, living healthily in all kinds of ways. Much like the people who buy vitamin pills. Lusty walks around country mansions. Cycling to work. That kind of thing.

Of course there may yet be something valuable in the antioxidant story, although it's probably not going to be as simple as dishing them out by the spoonful. And of course observational studies aren't inherently evil or useless: they're frequently fascinating, as part of a puzzle. These are all interesting theoretical research findings, as we try to puzzle out the roots of cancer and heart disease.

But they make a pretty thin excuse for flogging chocolate and alcohol. And somewhere out there—right now—a researcher is rubbing their hands with glee, poring over a press release, picturing themselves in the Today programme studios, planning some choice quotes for the Daily Telegraph: something racy about mince pies cutting heart disease because of the raisins, perhaps, or red wine helping you run faster. Well, it's Christmas. Have another."

We may be preaching to the choir with many of our attempts to improve health journalism if we only reach reporters. The editors to whom they report may be the most important group to reach to effect change.

With that goal, I'm grateful that The American Editor, a publication of the American Society of Newspaper Editors, published my article, "Misplaced priorities in health news coverage."

We’re in the middle of the November TV ratings/sweeps period. TV stations at these times often suddenly like to show a great interest in health care stories because their consultants tell them that viewers want health care news. (Why they don’t give it this attention the rest of the year is unknown.) But health care is not a topic that you can suddenly dust off and act like you understand it. There must be a daily commitment to the issues and to understanding what’s important for consumers to understand.

Last week, WCCO, a top-rated station in a major market (Minneapolis) delivered a story with a tone that suggested that the station felt it had uncovered a major issue: that health plans were giving doctors a financial incentive to prescribe a certain percentage of generic drugs.

Here’s the full text of the story.

It never explained why generic drugs are important in the nation’s cost control effort (if there is one).

It never interviewed a physician about his/her practice of prescribing generic drugs.

It quickly threw out a line that said “This practice is known as ‘pay for performance' ��? – never explaining anything about the much broader definition of “pay for performance��? or why it is being implemented in settings across the country or why many health policy experts think it is a wise move.

It profiled a patient who didn’t match the contrived controversy the station was presenting. The patient said he tried generic drugs but he suffered side effects, so his doctor prescribed a brand name drug. So what’s the story? No one forced anyone to do anything. And the patient says he’s now happy. Controversy? More like viewer confusion!

For some reason, WCCO only mentioned two health plans that use the generic incentives but there are others who do this that weren’t named.

Anyone who knows me knows I'm no apologist for the health insurance industry, but I felt compelled to get health plans' reaction to this story.

Spokesman Greg Bury of Medica (which was named) wrote me:

The piece did little to educate consumers about generic drugs and their role in treatments, the practice of medicine and efforts to control health care costs.

As it was pointed out to WCCO, the drugs qualifying for the incentive have the exact same active ingredients as their brand-name counterparts. The FDA ensures that they are the same. Generic drugs started out as brand name drugs; therefore, one could argue that they are a safer starting point for treatment thana brand name drug because of their track record for safety and efficacy.

Generic drugs help control the rising cost of health care. They typically cost 80-90% less than their brand name counterparts. These savings are passed along to patients because their lowest copay level typically applies. The cost structure of generics also helps slow the rise of health care premiums that are paid by plan sponsors - employers for most people - and consumers themselves.

Overall, the story is a missed opportunity to point out the value of generic drugs in the health care system. One has to wonder if WCCO is interested in helping its viewers understand the system and how they can benefit from it or if they are more interested in stirring controversy to boost ratings. We are in a sweeps period, aren't we?

Medical director Dr. Pat Courneya of HealthPartners (also mentioned in the story) wrote me:

The story sets up a false dichotomy, suggesting that brand name drugs are inherently superior in some way to generics. Despite decades of effort by the pharmaceutical industry to sow doubt about the safety and effectiveness of generic drugs, the evidence shows they are both safe and effective. They now account for the great majority of the drugs prescribed to patients. Doctors write these prescriptions despite the billions of dollars spent to market brand name alternatives. They do not do so disregarding the best interests of their patients.

Primary care doctors (I am a practicing Family Physician) would be insulted by the implication that we could be expected to "prescribe a certain number, percentage of generics, whether it's in the best interest of the patient or not." If I were told that, I would immediately protest and possibly contact an attorney. I have never been told to do anything whether it was in the interest of the patient or not, and I hope anyone who is would speak up.

Individual doctors do not get bonuses. Our financial rewards go to the medical groups – not individuals. Some medical groups use the money to further improve care for patients. For example one medical group used HealthPartners bonus to purchase a glucometer for their clinic so that diabetes patients could test their blood sugar and have the results in the exam room. The group was motivated to improve care for diabetes patients which is another measure in pay for performance.

If WCCO - or any news organization - invested in a full-time health care journalist - someone who fully developed health care reform issues such as generic substitution and "pay for performance" in its entirety - such pieces of naive, incomplete, pseudo-investigative journalism would not see the light of day. And the viewing audience would be better off.

Minnesota Medicine this month has a good summary of our work to date with HealthNewsReview.org.

Here's a guest editor column from one of our reviewers, Harry DeMonaco,  a Senior Clinical Associate in the Decision Support and Quality Management Unit of the Massachusetts General Hospital.  

News coverage of the recent American Heart Association Scientific Sessions (November 4 – 7) raises new questions about how journalists cover scientific meetings. On Monday November 5th, four news releases were issued under the banner of “Late-Breaking Clinical Trials and Special Sessions Coverage."

Three of the four studies addressed by the news releases received substantial news coverage, but one did not.  We couldn’t find any major news organization that covered the new findings from the OAT – or occluded artery trial. The results suggest that percutaneous coronary interventions (PCI)  - using coronary stents and balloons to open blocked blood vessels in addition to the use of clot-busting drugs – if done late after a heart attack offer no advantage but are considerably more expensive than medical therapy alone. 

To put this into context, there are over one million percutaneous angioplasty procedures performed in the United States each year. Although the trial did receive news coverage a year ago, the new study offered new evidence that neither primary nor secondary benefits exist to offset the cost of these procedures.  Many journalists must have received a Duke University news release, which included an investigator’s pithy summary: “What we have here is one of those cases where less is more.  While it may seem that going an extra step in opening up clogged arteries late in the game makes sense, we know that clinically, it doesn’t seem to offer the advantages we expected. In addition, the minimal initial benefits that patients with PCI enjoyed diminished over time. Coupling that with the higher cost, we now know that adding PCI to standard medical care in opening blocked arteries more than a day after a heart attack is not good value. In an era when the high cost of health care is the subject of intense debate, this study offers us one way we can offer high quality care for less money.”

Seems pretty newsworthy, doesn’t it?  But many stories focused, instead, on the potential of new drugs and new devices. 

While criticism of news coverage of scientific meetings is in many cases justified, the blame does not lie solely with the media.  Conference organizers, scientists and their affiliated institutions share in the responsibility.

What is the primary intent of the session?
Unfortunately the answer depends on whom you ask.  The sponsors of the session undoubtedly seek to inform members of the organization of the most up to date information in their field.  However, media interest translates into advertising dollars for the organizers.  Greater media interest also fuels subsequent years’ sessions attracting marquee scientists and their affiliated institutions. For the individual scientists, the primary intent is to share information, seek peer review and advice and obtain some level of notoriety.  The academic institutions associated with the scientist know full well that media attention can help attract patients and money from donors as well as corporate sponsors of research.  Journalists should ask: Do conference organizers decide which press releases to write based at least in part on marketing rather than science or importance?  Relying on press releases may not be in the best interest of the media – or of the public they serve. 

Can the results of studies publicized at scientific sessions be viewed as important or conclusive?
It is important to recognize that in many instances the research presented at scientific sessions has not been peer reviewed and as such should be viewed with some degree of skepticism.  A measure of the relative value of research presented at annual scientific sessions may be the rate of subsequent publication in high quality medical journals.  A 2002 study published by Schwartz and colleagues tracked the publication history of research published in abstract form at five different scientific sessions held in 1998.  A total of 252 media reports were generated by 147 abstracts.  In the three years following the meetings only 50% of the research originally reported in abstract form was published in high quality medical journals. One would assume that newspaper front page reports of research results would fare better, but this is not so. A total of 39 abstracts received front page coverage fared no better in their eventual publication rates.  Not surprisingly, abstracts that were promoted in official press releases were more likely to obtain front-page coverage but no more likely to be published in a top medical journal. 

What research deserves coverage by the media?
As was noted by Schwartz and her colleagues, session buzz and press releases may not be a reasonable measure of importance.  Few, if any, studies are definitive.  Medicine is iterative and moves based on accumulated knowledge.  Given the nature of medicine then, it is not surprising that today’s breakthrough is tomorrow’s disappointment. 

Newspapers that find many column inches to give to baseball batting averages may want to find room for posting long-term research success rates.